Monday, August 31, 2009

Heading over to the Guardian of UK today to check the comments on my essay on the Jaycee Lee Dugard case, I was excited to stumble across a new essay by Richard Bentall. For those of you who don't know him, in my opinion Bentall is one of the most important voices in the mental health field today. His new book, Doctoring the Mind, is an outstanding, empirically based critique of modern biological psychiatry, and its abysmal failure -- all hype to the contrary -- to improve the human condition. His Guardianessay, excerpted below, briefly summarizes his main arguments:

. . . Surveying the history of psychiatry, the medical historian Edward Shorter remarked: "If there is one central intellectual reality at the end of the 20th century, it is that the biological approach to psychiatry – treating mental illness as a genetically influenced disorder of the brain chemistry – has been a smashing success."

Far from being a success, there is compelling evidence that the biological approach has been a lamentable failure. Whereas last century saw dramatic improvements in the survival rates of patients suffering from heart diseases and cancer, so far as we can tell, outcomes for patients suffering from the severest forms of psychiatric disorder – the psychoses . . . – have hardly changed since the Victorian period. . . .

At the beginning of the 21st century a new picture of severe mental illness is emerging, which shows that the genetically determined brain disease paradigm is not only ineffective but scientifically flawed. First, it seems that diagnoses such as schizophrenia and bipolar disorder do not identify discrete conditions analogous to, say, appendicitis or tuberculosis. Patients with a mixture of bipolar and schizophrenia symptoms are at least as common as patients who fit one or other diagnosis. The concept of schizophrenia is so broad that two patients can share the diagnosis while having no symptoms in common.

In the case of both types of symptoms, there appear to be many people whose experiences place them on the borderline between health and illness, so that we can think of a spectrum running from ordinariness, through eccentricity and creative thinking, to full-blown psychiatric disorder. Research has also shown that psychiatric diagnoses are poor predictors of response to treatment, giving little indication of which patients will respond to which drugs. They are therefore hardly more meaningful than star signs – another diagnostic system that is supposed to tell us something about ourselves and what will happen in the future, and which is widely embraced despite no evidence of its usefulness.

When new methods of molecular genetics have been used to study psychiatric patients, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to psychiatric disorder, and that these effects are highly non-specific (the same genes are implicated in patients with different diagnoses).

Some findings that were announced with enormous fanfare have not been replicated in subsequent studies. . . . This . . . is consistent with other evidence that life experiences shape even the most severe forms of mental illness. Migrants have at least a four times greater risk of psychosis than other groups, and this effect is most pronounced if they live in areas in which they are in a minority. Early separation from parents has also been shown to increase the risk of psychosis, as have growing up in an urban environment and chronic bullying.

Many studies have also reported an association between trauma in early life and psychosis. These effects are large [and] understandable in the light of psychological research. . . .

The cruel and ineffective treatments that characterised psychiatry in the mid-20th century -- for instance, prefrontal leucotomy and insulin coma therapy -- would not have been accepted had psychiatrists not been in thrall to the idea that mental illnesses are genetically determined brain diseases. Today, although mental health professionals are usually much more compassionate than in those dark times, psychiatric services continue to see their primary objective as ensuring that patients take their medication.

Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.

Meanwhile, research on the biology of severe mental illness continues to be prioritised over social and psychological research. . . . There is therefore an urgent need to develop a less drug-based, more person-centred approach to understanding and treating mental illness, which builds on the recent scientific findings and which takes the experiences of patients seriously.

Saturday, August 29, 2009

The Guardian of UK asked me to write a comment on the extraordinary saga of Jaycee Lee Dugard. I'm posting the first few paragraphs here, with a link to the Guardian website for the full article and the comments, many of which are quite interesting. (I posted a couple of my own comments to the comments.)

In these harsh economic times, the saga of Jaycee Lee Dugard is especially riveting to the public imagination. Our horror and revulsion unite us. Who can we blame? How could this monster hide amongst us while committing unspeakable acts against innocent children?

Our collective furor and thirst for vengeance run counter to the principles of our justice system, under which a criminal defendant is presumed innocent until proven guilty. Psychiatric issues will make justice especially slow for Phillip Garrido, the registered sex offender who is accused of holding Dugard hostage for 18 years, after kidnapping her in June 1991 when she was just 11. (Garrido and his wife Nancy have both denied the charges.)

Initial evidence points toward a psychosis. In an interview from jail, Garrido called Dugard's story "heartwarming" and referenced secret documents and "hundreds and hundreds of thousands" of lawsuits. And that is just the tip of the iceberg. The wonders of the internet allow us to travel back in time and enter his mind, via rambling blog posts about voices in his head, mind control, and religious delusions of himself as the savior.

Ironically, more than a year ago Garrido referenced the potential for psychotic symptoms to cause violence against children. A woman who drowned her three children in the San Francisco Bay was, he wrote, "led by a powerful internal and external (hearing) process that places the human mind under a hypnotic siege that in time leads a person to build a delusional belief system that drives them to whatever course of action they take."

Sunday, August 23, 2009

The Minnesota Multiphasic Personality Inventory is the most widely used and best known personality test in the world. Daily, it is introduced in court in everything from child custody cases to civil lawsuits to criminal proceedings. Despite the fact that public tax monies sponsored its original development, it's become a major cash cow for the University of Minnesota, raking in about $1 million a year in royalties. But now, media focus on a bitter professional dispute is causing some in the field to wonder whether the legendary test has seen its day.

At issue is last year's "dramatic makeover" of the highly profitable septuagenarian. The slimmed-down MMPI-2-RF (restructured form) has just 338 questions rather than the old test's 567.

Leading the critics is James Butcher, a retired psychologist whose career centered around the old MMPI-2. He claims the MMPI-2-RF is so radically altered that it amounts to a new instrument. "These folks have made a new test and they are using the name MMPI ... with all the 70 years of tradition to market [it]." If he's right, of course, then all of the myriad studies and normative data on the old test are irrelevant to interpreting scores on the MMPI-2-RF.

Of even more direct relevance to us forensic folks is the controversy surrounding the new "Fake Bad Scale." As I've blogged about previously (links below), the "FBS" is being used to brand personal injury claimants as malingerers. Critics say the 43-item scale "discriminates against women and is prone to 'false positives.' "

Defenders of the new test deride critics as "the Mult Cult" (a twist on Multiphasic). And, to be fair, some do have a vested interest in the previous edition: Butcher earns a 30 percent cut of the $600,000 annual royalties on the MMPI-2's computerized interpretation system.

All of the hoopla has led to a series of formal investigations. In one, a university audit revealed that most of the MMPI research grant money was going to projects involving advisory board members of University Press's test division, who in some cases had even reviewed their own grant proposals.

The Press's solution to the controversy, according to the Star Tribune, is to "let the marketplace decide."

Hmmm. Is the marketplace really the best judge of good science?

The hoopla is likely to benefit the MMPI's competitors. In forensic circles, the test's former monopoly hold is giving way as the Personality Assessment Inventory and other newer instruments gain ground.

Whatever side we practicing psychologists choose, the major test distributors won't care. They distribute them all, and they will continue to rake in enormous sums of money. Don't you just love those over-the-top shipping and handling fees charged by you-know-who?

Friday, August 21, 2009

Six-pack photo lineups -- perhaps the single largest cause of wrongful convictions.

Frustrated with a string of wrongful convictions, the Dallas police department is now the nation's largest force to use sequential blind photo lineups -- a widely praised technique designed to reduce mistakes made by witnesses trying to identify suspects.

Dallas is not the first department to use the pioneering method. But experts hope that by using it in the county that leads the nation in exonerating wrongly convicted inmates, Dallas will inspire other departments to follow suit.

"If Dallas can do it ... then others are going to rise to the occasion," said Iowa State psychology professor Gary Wells, a national expert on police lineups.

The department switched to sequential blind lineups in April. Before that, Dallas police administered most lineups using the traditional six-pack -- law-enforcement lingo for mounting six photos onto a folder and showing them to a witness or victim at the same time.In sequential blind lineups, mug shots are shown one at a time. Detectives displaying the photos also don't know who the suspect is, which means they can't purposely or accidentally tip off witnesses.

Showing possible suspects all at once tends to make a witness compare the mug shots to one another, Wells said. But if they are shown sequentially, "witnesses have to dig deeper, compare each person to their memory and make more of an absolute decision."

Thursday, August 20, 2009

Mark your calendars for the upcoming AP-LS conference, to be held March 18-20, 2010 in Vancouver, BC. The deadline for conference submissions is October 5. Information about the conference is available at the conference website. Proposals for posters, papers, and symposium can be submitted HERE.

Risk for Sexual Violence Protocol (RSVP)

On October 22, Stephen Hart is going to be down in Portland, Oregon, giving an all-day training on his newly developed instrument, the RSVP (which replaces the Sexual Violence Risk-20 instrument). Dr. Hart is well worth catching. A member of the Mental Health, Law, and Policy Institute at Simon Fraser University in Canada, he is an internationally renowned researcher, forensic psychologist and past president of the American Psychology-Law Society. More information on the training is at the website of Northwest Forensic Institute.

In its award letter, the Council commended Balfour for performing "a valuable service to society by using the power of the media as a catalyst for pursuing justice."

Balfour will be honored at the 14th International Conference on Family Violence, Abuse and Trauma on September 25 in San Diego, California.

Meantime, word is out that the San Mateo County (California) District Attorney's Office has decided to retry Ayres after extensive talks with jurors who deadlocked in favor of conviction on most counts.

Ayres, 77, is a former president of the American Academy of Child and Adolescent Psychiatry who treated hundreds of delinquent boys sent to him by the county's juvenile justice system. He was charged with molesting six of these former patients under the guise of giving them medical exams.

Tuesday, August 18, 2009

We all know what an unmitigated disaster the Drug Wars have been. Here at Ground Zero (California), prison guards live large while public schools crash and burn. (We used to have among the best schools in the United States; now we are at the bottom.) Membership in the guards' union has soared from 2,600 to 45,000, while correctional salaries rose from $15,000 to -- in some cases -- $100,000 a year or more. (Laura Sullivan at NPR has an informative piece on Folsom Prison as an exemplar of this process. Folsom used to rehabilitate its prisoners; now it's a "merry-go-round" with no escape.)

Have we learned from the failed Drug Wars? Nope. Instead, we are on the cusp of a new and massive criminalization effort, this time targeting the bogeyman sex offender.

He predicts that the changes being wrought by the Adam Walsh Child Protection and Safety Act ("AWA") of 2006 may bring "repercussions as substantial as the drug war has had on American criminal justice and society."The ratchet effect

By now, we really should know better than to allow this further destruction of our civil society. Even the Economist of London, hardly a bastion of liberal politics, is lambasting the laws. The August 6 issue includes both a leader and a more in-depth article explaining why America’s sex laws are "unjust and ineffective." As the subhead puts it:

"An ever harsher approach is doing more harm than good, but it is being copied around the world"

"Individual American politicians have great latitude to propose new laws. Stricter curbs on paedophiles win votes. And to sound severe, such curbs must be stronger than the laws in place, which in turn were proposed by politicians who wished to appear tough themselves. Few politicians dare to vote against such laws, because if they do, the attack ads practically write themselves.

"In all, 674,000 Americans are on sex-offender registries -- more than the population of Vermont, North Dakota or Wyoming…. [A]t least five states require registration for people who visit prostitutes, 29 require it for consensual sex between young teenagers and 32 require it for indecent exposure. Some prosecutors are now stretching the definition of 'distributing child pornography' to include teens who text half-naked photos of themselves to their friends.

"How dangerous are the people on the registries? A state review of one sample in Georgia found that two-thirds of them posed little risk. For example, Janet Allison was found guilty of being 'party to the crime of child molestation' because she let her 15-year-old daughter have sex with a boyfriend. The young couple later married. But Ms Allison will spend the rest of her life publicly branded as a sex offender."

Yung too discusses some of these unintended consequences, including the harm to innocent parties. Other examples can be found daily in the popular press. For example, today's Raleigh (North Carolina) News and Observerreports on the travesty of convicted sex offenders being denied the right to worship, and one church choosing to move its children's programs off-site to protect a sex offending parishioner.

As I've reported before, the sexual predator hysteria is creating a widespread phobia of men in contact with children. Columnist Jeanne Phillips (Dear Abby), for example, is fueling panic about the dangers of public men's rooms. As San Francisco Chronicle columnist Jon Carroll sardonically responded:

"When did the idea get out that men's rooms were a secret hotbed of molestation? I mean, there are some men's rooms -- including, apparently, one in the Minneapolis airport -- where consensual homosexual activity between adults has been known to happen. But that's not at all the same thing as child molesting; that's just a form of speed dating. Men's rooms, may I say, are boring. Ain't nothing going on in them. Molestation typically happens in other places, usually in a private home. And statistically it's no more common than it was 30 years ago. As I've said before, if you're looking for the people most likely to molest your child, look at the members of your own family, because that's how it usually happens. People don't want to admit that, so they invent phantom pedophiles in the nation's men's rooms."

But above and beyond all of these unintended consequences, I predict that years from now we will look back and realize not just what we already know -- that we destroyed many lives unnecessarily, bankrupted our schools and other public institutions, and curtailed civil liberties on a massive scale -- but, more fundamentally, we actually created the creature we feared.

Creating the bogeyman: "Mike"

Let's take "Mike." An average, red-blooded 19-year-old American, he dated a cute 16-year-old girl. Like thousands of other young men, he was arrested, and forced to register as a "sex offender" for life. No matter that his behavior was not deviant. Three years is a standard age gap between young men and women for dating in our culture, as it has been forever. I happened to see the obituary of an 89-year-old man who before his demise had celebrated his 70th wedding anniversary. His wife was 86. Do the math. If he had been born 70 years later, he'd be a sex offender for life. Unable to live freely, work, or even attend church, he probably wouldn't have led such a successful life. After all, as social psychologists can tell you, the environment is at least as important to behavior as any psychological characteristics. Probably far more so.

Back to Mike. As I said, there's nothing wrong with Mike. But no matter. Like everyone else, he must undergo mandatory "treatment" for "statutory perpetrators" (yes, that's what treatment providers are calling guys like Mike).

The treatment of choice is cognitive-behavioral therapy. Its mantra, as Dany Lacombe of Simon Fraser University in Canada found in an ethnographic study of one prison-based treatment program, is:

"Once a sex offender, always a sex offender."

"Sex offending is like diabetes," a program therapist tells the assembled sex offenders. "It will not go away. You cannot be cured. We don't use the C word here. But can you be managed? Yes. Treatment is all about managing your risks to re-offend."

Despite little empirical support for this approach, Mike will be trained to understand his "cycle" of offending and develop a relapse prevention plan that focuses on controlling "deviant sexual fantasies." He will have to generate a log of sexual fantasies. If he denies deviant fantasies, or doesn't see the connection between his fantasies and his offending, he will be accused of not cooperating. He will learn to create deviant fantasies "to keep the therapists at bay."

As Lacombe quoted one 18-year-old, in the article in the British Journal of Criminology:

"They want to hear that I always have fantasies and that I have more bad ones than good ones. But I don't have bad ones that often. I make up the bad ones. I make them really bad because they won’t leave me alone."

Through the treatment process, Mike and others will learn to think of themselves as "beings at risk of reoffending at any moment." Indeed, if treatment is successful, Mike will become a virtual "confessional machine," "expected all his life to narrate his darkest fantasies to criminal justice officers and significant others who are enlisted to help him control his risk."

The iatrogenic process

As you probably know, iatrogenesis refers to the situation in which treatment creates or exacerbates an illness or adverse condition. In the context of sex offender treatment and management, here's how the process works:

Saturate popular culture with hypersexual advertising and degrading, misogynistic pornography.

When men succumb to the allure and experimentally transgress, label them as lifelong "sex offenders."

Through mandatory "treatment," reprogram them into dark and dangerous deviants, "a species entirely consumed by sex."

Finally, restrict their freedoms so severely that few if any prosocial life courses remain open.

Through exercises of moral regulation, then, the government, law enforcement, media, and therapists collude to transform sex offenders into a strange and different "other," no longer recognizable in their ordinariness.

While this makes Mike more closely match the public's conception of the bogeyman sex offender, is this helpful in the long run, either to him or to society more broadly? By brainwashing thousands of men to think of themselves as nothing more than perpetual sexual deviants, might we not be producing the very risk we have imagined and then sought to ameliorate?

Monday, August 10, 2009

Having worked in a prison segregation housing unit, I can tell you that such housing units wreak havoc on the fragile psyches of mentally ill prisoners. In a new article, prison authority Terry Kupers (author of Prison Madness) and a group of 13 colleagues explore what happened when Mississippi was forced through class-action litigation to remove mentally ill prisoners from Parchman's "Unit 32" and to provide them with treatment. The result? Not surprisingly, the prison saw "large reductions in rates of misconduct, violence, and use of force."

As you may imagine, getting accurate information on the prevalence and features of sexual assault in prison is a difficult task. Among the many challenges are "working cooperatively with state agencies while maintaining independence, gaining access to prisons and prisoners, securing necessary institutional approvals, and collecting generalizable data on a highly sensitive topic." The federal Prison Rape elimination act (PRea) of 2003 increases opportunities for research, however, and a group of scholars tells us how it is done. Lead author Valerie Jenness of UC Irvine is a noted authority on hate crimes. In this article in Criminal Justice Policy Review, Accomplishing the Difficult but Not Impossible: Collecting Self-Report Data on Inmate-on-Inmate Sexual Assault in Prison, she and co-authors describe their research procedures, in the hopes of reversing the recent decline of in-prison research by encouraging other researchers to sally forth.

Friday, August 7, 2009

Remember the case of the Norfolk 4, which I've blogged about before? That's the 1997 rape-murder case that has become an exemplar of wrongful convictions, the topic of a book by confession scholar Richard Leo and an upcoming screenplay by bestselling author John Grisham.

Yesterday, Virginia Governor Tim Kaine issued partial pardons to three of the four sailors, paving the way for their imminent releases. The fourth sailor was released in 2005. In his statement, the governor noted that the men's confessions contradicted forensic evidence, that no physical evidence linked the men to the crime scene, and that another man had confessed and asserted that he acted alone. That man's DNA matched evidence found at the scene.

The case was highly unusual in that even a group of former FBI agents was lobbying for the pardon.

But guess what? The pardons are only "partial" rather than full vindications. That means the men's convictions will stand, and they will be required to register as sex offenders. And all of you readers know what that means: Even though most intelligent people know they were innocent, they will have a hard time finding anywhere to live, and very few employers will have the courage to hire them.

I recently blogged about an upcoming article in Criminal Justice and Behavior on the use of actuarial tools to predict juvenile sex offender recidivism. (They don’t work.) Thomas Mankowski, the criminology editor at Sage Publications, who also runs the website of the International Association for Correctional and Forensic Psychology (which owns Criminal Justice and Behavior) just so happens to be a follower of this blog, and he kindly offered to let my readers download the article for free. You should be able to download the entire article ("Assessment of Reoffense Risk in Adolescents Who Have Committed Sexual Offenses: Predictive Validity of the ERASOR, PCL:YV, YLS/CMI, and Static-99" by Jodi Viljoen and colleagues) for free by clicking on the download button, above. I also recommend that you check out the IACFP's blogs section; it's got lots of great news and commentary. Thanks, Tom!

30% discount on IACFP membership

Tom is also offering my blog readers a special rate of 30% off membership in the Association for Correctional and Forensic Psychology. The IACFP is an organization of behavioral scientists and practitioners concerned with delivery of high-quality mental health services to criminal offenders, and with promoting and disseminating research on the etiology, assessment, and treatment of criminal behavior. Membership benefits include subscriptions to Criminal Justice and Behavior (click HERE for a free sample issue) and a quarterly newsletter, The Correctional Psychologist, free access to more than 55 criminology journals online, and discounts on various books, educational materials, and conferences. With the discount, a one-year membership is $52.50; student membership is $25. Click HERE to take advantage of this offer. When checking out, enter the Promo Code JULY30% in the "Comments and Special Instructions" field. (Orders are processed manually, so the regular fee appears during checkout but you will be charged the discounted amount.)

Wednesday, August 5, 2009

"Gay panic" is a controversial defense typically invoked when a heterosexual man murders a gay man, claiming the gay man made an unwanted sexual advance. Critics have called for legislation to abolish the defense on the grounds that it capitalizes on unconscious prejudice by invoking the stereotype of gay men as sexual predators. But legal scholar Cynthia Lee takes a different approach. In a new article, the law professor at the George Washington University Law School argues that abolishing the defense will have the unintended consequence of allowing it to slither into court on the down low.

"Trying to change social norms by suppressing norms with which one disagrees is not the best way to bring about lasting change.... Trying to force such change through legislative or judicial bans will only succeed in driving these arguments underground where they can appeal to subconscious bias."

In addition, attempts to bar the construct may run afoul of defendants' Constitutional right to present a full defense.

Instead, the defense should be allowed but openly challenged. Indeed, Lee argues, the criminal court is the ideal forum for an open and honest discussion of sexual prejudice and the law.

Just as recent research suggests that jurors do a better job in race-related cases when race is made consciously salient, Lee advises the same for sexual orientation bias. She advises prosecutors to identify and attempt to exclude potential homophobes in the jury pool, and to "make sexual orientation salient" throughout the trial by directly challenging defense attempts to stereotype gay men as sexual deviants or predators.

Lee does a great job summarizing the history and contemporary uses of gay panic, including in the high-profile cases of Billy Jack Gaither (the topic of a PBS Frontline episode featuring yours truly), Jonathan Schmitz (referencing the Jenny Jones show case that Greg Herek and I discuss in our encyclopedia article on anti-gay violence), Timothy Schmick, David Mills, Matthew Shepard and Gwen Araujo.

Her lengthy and well-argued treatise draws on disparate theoretical strands, including First Amendment legal theory, cutting-edge social science research on implicit bias, and arguments regarding the competency of judges as evidence gatekeepers.

In the end, she says, "the law can and should play a role in mediating th[e] cultural dispute [over the status of homosexuality] – not by dictating what jurors can and cannot consider, but by making sure jurors are cognitively aware of what exactly is at stake when a gay person is the victim of fatal violence, and the person who killed him claims he did so in response to an unwanted sexual advance."

Monday, August 3, 2009

I've blogged a few times about deportations in which ICE officials accidentally scoop up U.S. citizens and whisk them off to foreign lands where their families cannot find them. Mentally ill people are especially at risk, due to their potential to become confused. But in one of the more outlandish cases, 52-year-old Leonard Robert Parrish, an African American chef in Houston, was recently detained by ICE because a jailer thought his Brooklyn accent sounded foreign.

As it turns out, such cases are far from rare. A special report in the San Francisco Chronicle suggests that among the 400,000-odd people detained annually by ICE, hundreds may be U.S. citizens who are wrongly suspected of being foreign.

Once detained, these people may find it difficult to get out of the system. Immigration detainees, unlike those in the criminal justice system, lack due process protections such as the right to legal counsel or telephone calls. Many are poor, and some are mentally ill.

"If it can happen to U.S. citizens, you can imagine how few procedural protections are available to everybody else," says Chuck Roth, litigation director for the National Immigration Justice Center in Chicago.

My advice: If you are working with anyone whose citizenship status is less than crystal-clear (such as naturalized citizens), encourage them to get their papers in order. In this time of anti-immigration paranoia, better safe than sorry.

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Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California. She is a former criminal investigator and legal affairs reporter. This blog features news and commentary pertaining to forensic psychology, criminology, and psychology-law. If you find it useful, you may subscribe to the newsletter (above). See Dr. Franklin's website for more information.

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